Cystadenomata are the most common benign tumours of the exocrine pancreas.
These well-circumscribed masses are composed of multiple cystic cavities lined
by serous
or mucin-secreting epithelium.

Carcinoma of the pancreas is increasing in incidence Carcinoma of the pancreas
is one of the
most common causes of death from cancer, with an increasing incidence in Western
countries.
Although it is predominantly seen after the age of 60 years, there are
occasional
cases in younger patients.

Most carcinomas of the pancreas are adenocarcinomas. They arise with different
frequencies in different parts of the pancreas.
Carcinoma in the head of the pancreas tends to present early with obstructive
jaundice.
As a result, tumours are, on average, smaller at diagnosis than in other sites.
Histologically most tumours are moderately differentiated adenocarcinomas.
The prognosis for carcinoma of the pancreas is extremely poor, 90% of patients
dying
within 6 months of diagnosis.

The only environmental factor that is firmly associated with carcinoma of the
pancreas is smoking.
It has been speculated that dietary factors and exposure to chemical carcinogens
may be
contributory, but no definite risks have been determined. Diabetic women have an
increased
risk of development of pancreatic carcinoma.

Histologically most tumours are moderately differentiated adenocarcinomas with a
prominent
fibrous stroma. Less common histological variants are also described.
The main routes of spread are:
• Local, causing obstructive jaundice, or invasion of theduodenum.
• Lymphatic, spreading to adjacent lymph nodes.
• Haematogenous, spreading to the liver.
The prognosis for carcinoma of the pancreas is extremely poor, 90% of patients
dying within
6 months of diagnosis. Palliative surgery is often performed to bypass
obstruction of
the bile duct (relieving jaundice) and obstruction of the duodenum.
Pancreatic carcinoma is associated with several clinical syndromes:
• Weight loss, anorexia and chronic persistent pain in the epigastrium,
radiating to the back.
• Obstructive jaundice with painless palpable dilatation of the gallbladder
(Courvoisier's sign).
• Migratory thrombophlebitis, in which there is development of multiple
thromboses in
superficial and deep leg veins (Trousseau's syndrome).

Tumours appear as gritty, grey, hard nodules, irregularly invading the adjacent
gland and
local structures
(a). Histologically
(b) they are usually moderately differentiated adenocarcinomas,
which are composed of gland spaces in a fibrous stroma.

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